Mediclinic surgeons perform streamlined brain surgery with new endoscope

Posted on 10 May 2023

Neurosurgeons Dr Brad Harrington and Dr Hanno Vivier, both of Mediclinic Cape Gate, recently performed a navigated ventriculostomy surgery to remove a potentially life-threatening colloid cyst – a tumour that blocks the flow of cerebrospinal fluid in the brain.

When the patient in question first came in, his cognitive functioning was significantly impaired. “He was semi-comatose when he presented,” Dr Harrington explains. His condition was the result of a build-up of cerebrospinal fluid caused by a colloid cyst blocking the normal fluid flow through the third ventricle of the brain.

Due to the raised intracranial pressure and the patient’s deteriorating condition, the cyst required urgent removal. If left untreated, the rising pressure could result in death.

While it’s an uncommon condition, several tried and tested approaches exist to remove colloid cysts. “Traditionally these cysts were removed via a craniotomy that usually involves big openings and a lot of work to get there due to the tumour’s deep location”, Dr Harringtonsays.

“Years ago, we did these operations as an open procedure, where you made an incision of 7-8cm on the skull,” explains Dr Vivier. “You’d have to remove a piece of the skull to get inside, either approaching it through the frontal lobe or splitting the two frontal lobes and then going in.”

While a positive outcome is expected, there’s a risk that such an approach could lead to potential complications, for example, bleeding and damage to surrounding structures, Dr Harrington adds.

What’s more, says Dr Vivier, this colloid cyst develops very close to important structures in the brain, including certain blood vessels as well as the fornix. “Your memory is situated in the fornix, and if you damage this with bigger instrumentation, then the patient can have significant memory deficits.”

Minimally invasive surgery

Combining the newly launched Aesculap MINOP InVent endoscope and instrument set with a Söring aspirator for the first time , Dr Harrington and Dr Vivier performed a minimally invasive and successful surgery. Dr Vivier explains why the less invasive, endoscopic approach was preferable in this case: “With the help of the technology, we can make a much smaller incision of about 2cm or so. We drill only one hole and go through this with the endoscope. We make a small hole on the right frontal area of the skull, and then go into the lateral ventricle using the endoscope – which has channels to work through. Here you can see the tumour and treat it with the aspirator.”

What set their surgery apart was using the ultrasonic aspirator in conjunction with the endoscope, adds Dr Harrington. He explains the reason this combination was novel: “The ultrasonic aspirator breaks down the tumour tissue and sucks it out, and this particular Aesculap endoscope has a wide enough working channel to allow the aspirator to pass through it.” Other instruments are then passed through the endoscope to dissect off the tumour, ensuring it’s entirely removed with little impact on the brain tissue.

This approach can only be used in cases where the anatomy of the tumour makes it feasible, Dr Harrington adds. But when viable, it comes with less risk to patient. Having two neurosurgeons as well as an expert team on board was also a game-changer. “The surgery highlighted the value of such an approach in these cases, because you’re able to remove the tumour with so little impact to surrounding structures and tissues.”

Speedy recovery

It’s all about the right combination of medical expertise and tools. The patient has made a speedy and full recovery and is now functioning normally. Aside from a faster recovery, says Dr Vivier, this endoscopic surgery also creates a small wound with less chance for infections and postoperative complications.
The success of the surgery also shows how important it is to stay abreast of the latest medical technology, says Dr Harrington. “It highlights the value of seeing what technology is available and how it’s being used; and then being willing to adopt those proven advances and change our approach.”

He commends Dr Vivier for advocating a shift in mindset.

“As my professor told me 20 years ago,” says Dr Vivier, “it’s better to operate smaller with as little risk to the patient as possible”.

Published in Innovation